25 - Management of the obese parturient

Summary

Both obesity and excessive maternal weight gain during pregnancy contribute to increased difficulties and risks of general and regional anesthesia techniques. In the pregnant woman, cardiovascular changes due to an increase in oxygen demand include increased cardiac output and blood volume expansion coupled with reduced systemic vascular resistance. Obstructive sleep apnea is not uncommon in the obese parturient, and these patients are at increased risk of systemic and pulmonary hypertension, and coronary artery disease. In the obese parturient there is a higher risk of other delivery and post-partum complications. Analgesia during the labour is demanded more often due to the more painful uterine contractions in obese patients. Spinal anesthesia is often used for elective Cesarean delivery. The peri-operative management of the mobidly obese (MO) parturient is associated with increased risks and difficulties hence demanding a multidisciplinary approach.